Healthcare Provider Details
I. General information
NPI: 1790988418
Provider Name (Legal Business Name): A & A DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7880 BROADWAY SUITE A
MERRILLVILLE IN
46410-5566
US
IV. Provider business mailing address
7880 BROADWAY SUITE A
MERRILLVILLE IN
46410-5566
US
V. Phone/Fax
- Phone: 219-795-9999
- Fax: 219-795-9590
- Phone: 219-795-9999
- Fax: 219-795-9590
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 122300000X |
| Taxonomy | Dentist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1223P0300X |
| Taxonomy | Periodontics |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
CRESHINDA
DENISE
AYANGADE
Title or Position: DENTIST
Credential: DMD
Phone: 219-795-9999